SynthesisFrontiers in medicine2026
Efficacy and safety of vismodegib in periocular and orbital basal cell carcinoma: a systematic review and meta-analysis.
Synthesis in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
Background: Periocular and orbital basal cell carcinoma (BCC) represents a therapeutic challenge due to its proximity to critical structures, the risk of disfigurement, and the potential need for exenteration in advanced disease. Vismodegib, a Hedgehog pathway inhibitor, offers a non-surgical alternative, but its overall efficacy and tolerability in this subset remain unclear. Aim: This systematic review and meta-analysis aimed to evaluate the efficacy, safety, and recurrence outcomes of vismodegib in periocular and orbital BCC. Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted. Eligible studies included prospective or retrospective cohorts and case series with ≥7 patients treated with vismodegib. Primary outcomes were complete and partial response rates; secondary outcomes included recurrence, exenteration, and adverse events. Pooled incidence rates with 95% confidence intervals (CI) were calculated using a random-effects model. Results: Eighteen studies, with 764 patients, were included. The pooled complete response rate was 38.4% (95% CI: 36.6-57.4), and partial response occurred in 39.2% (95% CI: 32.4-47.5). Recurrence following discontinuation was reported in 17.4% (95% CI: 7.0-30.3). Despite vismodegib therapy, exenteration was performed in 28.1% (95% CI: 12.3-34.5). Adverse events were almost universal (90.3, 95% CI: 81.0-94.8), with alopecia (57.1%), muscle spasms (65.8%), decreased appetite/anorexia (28.2%), and weight loss (38.2%) being the most frequent. Severe adverse events (grade ≥3) occurred in 25.5% of patients, and treatment discontinuation due to toxicity was noted in 31.2%. Conclusion: Vismodegib provides meaningful tumor regression in periocular and orbital BCC, enabling globe preservation in a subset of patients and reducing the need for exenteration. However, high recurrence rates after discontinuation and the substantial burden of adverse events limit long-term tolerability. Careful patient selection and close monitoring are essential for optimizing outcomes.
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